Please
note that this blog is longer than normal but we felt that breaking the blog
into two would have been artificial and would have broken up the flow of the piece.
Kieran

The first author (Ingeborg) recently
completed a thesis that studied the concerns expressed by individuals convicted
of sexual offenses. It examined their experiences with stigma, both in prison
and post-release, in Norway. The study is based on qualitative interviews with
eight adult men, all convicted of at least one sex offense. The eight men
interviewed were relatively recently released from prison, and most were still
subject to terms and conditions set by the Norwegian Correctional Services.
Five had been sentenced to regular prison sentences, two had been sentenced to
preventive detention, and one had been given a community sentence in addition
to imprisonment.

These men’s experiences in prison
involved hearing about and witnessing violence and threats towards other
persons convicted of sex offenses. A few of the men had been bullied themselves
by other prisoners. Internationally, these experiences are not unusual for
people incarcerated for sexual offenses. Some of the men were advised by prison
staff to come up with a believable cover story to avoid negative sanctions from
other prisoners. In some cases, these men told others that they had been
convicted for various petty crimes. In one case, a man had been advised by a
prison officer to simply state that he had ben convicted of fraud involving
welfare benefits. Not surprisingly, most participants did their best not to be
recognized as a “sex offender” in prison, although some could not avoid the
label. However, the all the men who took part in the research were all highly
aware that they were unwanted and seen as outcasts by the prison community,
never mind the general society outside of prison, which reemphasizes the stigma
that sexual offending elicits in society.

The experiences that these men had
in prison are relevant to their post-release use of coping strategies. The
results highlighted that the strategies used in most cases were a reaction to
and a result of others’ perceived attitudes towards people convicted of sex offenses
as a group. The strategies were not the result of a proactive desistence
strategy.

Informants in this study
experienced high levels of stress linked to being recognized as someone who had
committed a sexual offense, even after release. In many ways they limited their
own life opportunities as a result of trying to cope with the threats they
perceived. The reasons for these responses are easy to understand. In prison
they learned that their offenses would not be forgiven. They were told to lie
to stay safe. After release, their families and friends cut them off. Courtesy
stigma and episodes of informal notification by others of their crimes led them
to believe that there was no chance of redemption. Finally, through the media,
they learned that others with similar histories as themselves were considered
monsters. As a result, and as a group, informants in this study withdrew and
isolated more, and their self-images were in some cases affected negatively.

This study reflects broader
research in the field internationally, with many participants experiencing
broken bonds with family and friends and a negative portrayal in the media.
Further, they have seen how they are considered to be “monsters” in public
discourses, with the associated perception that they are always going to be a
threat. This is very relevant to post-release experiences in Norway, as media
accounts are widespread, and the country has a comparatively small population
and a deep sense of community that binds people together. Therefore, media
discourses feed into wider stigma.

These media processes and
resulting stigma are especially important because Norway is often seen as exceptional
when it comes to post-release reintegration and inclusiveness. These findings
challenge this belief. Norway does not have official registration and
disclosure policies for people convicted of a sexual offense, but the nature of
the offense was enough to create an informal, persistent label that the men
could not escape. In light of this, Ingeborg’s research examined participants’
perspectives of the way that they were perceived and labelled focusing on how
it impacted their self-image and capacity to desist as well as integrate back
into the community. The research found that some participants presented their
futures with hope and enthusiasm, while others seemed somewhat hopeless. The
men described how their status as a person convicted of sexual offenses did,
and could possibly, limit their opportunities to live the life they wanted post
release.

The recidivism rates for this
group of offenders are low* in Norway, as in the rest of the world. The
challenge is that research consistently finds that one of the greatest
contributors to desistance is strong social bonds and pro-social networks, but
the way that these men are labelled and viewed in society breaks these bonds
and, therefore, makes reoffending more likely. What the participants wanted was
to be able to be open about their conviction and treated like any other citizen
even though they had once committed a sexual offense. Their stories indicate
that there is a need to review the idea of the inclusive Norwegian society,
concerning this topic.

What is the international relevance of these findings
from Norway? These findings add to what has been known from earlier studies (Levenson,
Prescott, & Jumper, 2014; McCartan, Harris, & Prescott, 2019). Namely, that
understanding the service user perspective is central to public safety as well as
successful treatment and integration back into the community. Perhaps the most
puzzling aspect of studying the service user’s voice regarding their treatment
experience is how little study has taken place. Why? How is it that programs
don’t consider feedback? What gets in the way?

First, remember that understanding client experiences
and client satisfaction is not the same as monitoring outcomes or checking in
on the working alliance. Ensuring that clients are generally happy with
services is not the same as ensuring that those services are working, even
though the latter is unlikely without the former. It’s important to consider
every angle of the experience in order to produce services that effectively build
community safety.

Second, the working alliance is about more than just
the relationship; this has been found to be important in community supervision efforts as well as treatment. The working alliance involves
building agreement on the goals of rehabilitative efforts (which itself can
require a wide array of interpersonal skills). It also requires agreement on
the tasks of treatment and agreement on who the therapist is in the life of the
client. Finally, the alliance involves delivering treatment, supervision and
support in a manner that fits with the strong personal and cultural values of
the client.

Third, the vast majority of research into the
treatment of people convicted of sexual offenses is about the model used and
its impact in reducing re-offending, and not about behavior change or harm
reduction; both are helpful key performance indicators in treatment.

Fourthly, and perhaps the biggest barrier to honoring
the service user’s voice, is the belief of agencies and individual clinicians
that they are already doing it. It can be easy for professionals to assume that
they understand each client’s internal experience of treatment and to form
further assumptions and plans for treatment accordingly. Unfortunately,
research from within our field (Beech & Fordham, 1997 ) and outside it (Bertolino
& Miller, 2013) finds that therapists typically overestimate their
effectiveness. This can become a bitter pill to swallow, especially when so
many forms of psychological approaches already come with an implicit assumption
that treatment is something we do to our clients rather than with them or on
their behalf.

Finally, it is worth noting that
if we are truly to help efforts at public safety, it makes perfect sense to
study those who experience our interventions the most. As research indicates,
they are often the ones most motivated to make treatment work.

* In a Nordic study of
recidivism (Graunbøl et al., 2010), 3% of individuals convicted of sexual offenses in Norway recidivated
within 2 years after release from prison, none of them into new sex crimes.
Longer follow-up periods naturally provide higher recidivism rates, as
indicated by a 5-year sexual recidivism rate of 8% in Norway (Grünfeld et al., 1998).

McCartan, K.F., Harris, D.A., & Prescott, D.S.
(2019). Seen and not heard: The service user’s experience through the justice
system of individuals convicted of sexual offenses. International Journal of
Offender Therapy and Comparative Criminology, 1-17. doi:
10.1177/0306624X19851671.

Friday, February 14, 2020

NL-ATSA (the chapter of ATSA based in the Netherlands and Belgium),
the University Forensic Centre) (UFC) and the University of Antwerp organized
the second edition of the conference “At the Crossroads: Future directions in
sex offender treatment and assessment” in Antwerp, Belgium. The second
edition took place from the 6th – 7thFebruary in
Antwerp, following on from two days of pre-conference sessions focused on
treatment and risk assessment. The
conference was a real mix of research, practice, and policy with approximately
250 participants from the Netherlands, Belgium, Germany, Slovenia, Spain,
Iceland, USA, Canada, and UK; in addition Zuhal Demir, Flemish Minister of
Justice and Enforcement, opened the conference and attended the first session on the first day. In
this blog we are going to take you on a whistle-stop tour of the event.

The conference had 2 pre-conference sessions, which were separate from
but connected to the main conference, on Static-Stable-Acute training (Wineke
Smid, Minne De Boeck and Kasia Uzieblo) and how to effectively apply
Risk-Need-Responsivity principles to treatment (Sandy Jung). The first day of
the conference was all keynote sessions, which included, Maia Christopher
(ATSA) on working with victims organization to co-create effective public
policy; Erick Janssen (KULeuven) on the relationship between
arousal and emotions on decision making in risky sexual behaviors and/or sexual
offences; Georgia Winters (Fairleigh Dickson University) on sexual grooming
behaviour; Ross Bartels (University of Lincoln) on the sexual fantasies and
their role, or not, in sexual offending; and Nicholas Blagden (Nottingham Trent
University) in the importance of the rehabilitative climate and how prison can
be a place for therapeutic change. The second day the conference had started
out with two back to back workshop sessions: There were 5 sessions and they
were repeated twice which enabled the attendees to get the most out of the
conference. The workshop sessions were more practice-based and focused on
online sexual offences (Hannah Merdian, University of Lincoln), risk
communication (Daniel Murrie, University of Virginia), case formulation
incorporating risk assessment (Leam Craig, Forensic Psychology Practice, LTD),
sibling sexual abuse (Peter Yates, Edinburgh Napier University) and
professional self-care (Joanna Clarke, Petros People). The second half of the second day focused on keynotes from, Klaus Vanhoutte (Payoke) talking about
human trafficking, sexual exploitation and how the “lover boy method” could be
used to understand this process; Eric Beauregard (Simon Frasier
University) on research and practice into serial sexual homicide and what that
means for practitioners; desistance from online sexual offending (Hannah
Merdian, University of Lincoln); and how we move on from the crossroads in
terms of using evidence in policymaking (Kieran McCartan, University of the
West of England). On the second day, like the first, there were about 10 poster
presentations during lunch (21 in total) that highlighted the breadth and depth
of research in the Netherland, Belgium, Germany and UK on sexual abuse,
including, research on BDSM, Minor Attracted Persons, Stop it Now!, COSA &
Circles Europe, and desistance.

The NL-ATSA conference really highlighted the diversity of sexual abuse
and how wide, although interconnected, the field is. The multi-day
conference connected all the domains from theory to treatment with each
other. Current trends and lesser-known phenomena were also cited. For if
we don’t understand sex and sexuality in everyday life, how can we tell normal/accepted
sexual practices from “deviant”/non-normal ones? How can we understand the way
that the public, as well as policymaker, attitudes to sex and sexual abuse are
formed, and therefore how they impact real-world responses to sexual abuse? If
we do not know the difference between fantasying and doing, or viewing and
doing, how can we present first time offending or recidivism? If we do not know
how people groom, offend or behave, how can we prevent or respond to sexual
abuse? This also means that we must hear the client as the service user and
recognize professional experience and knowledge to frame best practice. So that
we can build rehabilitative climates that are fit for purpose, help treat
people and stop burn out in staff. Therefore, we must recognize that
rehabilitation is possible and that desistance can happen. The evidence base
in sexual abuse is often varied, but we do know that treatment/interventions
are more effective than doing nothing. Do we acknowledge that enough? And how do
professionals and researchers convey that to the public and policymakers? This
conference highlighted and incorporated all these points. Yes, we are at a
crossroads and we have been there for a time, but we need to go forward not
back. We go forward together united in a multi-disciplinary, multi-agency way
and by connecting all the different subdomains within our field. The conference
reinforced the importance of international collaboration, conversation, and
research.

Wednesday, February 5, 2020

Note: This is part 2 of a 2-part blog, Part
1 can be found here.
Kieran

One problem with working individually
to combat moral injury is that we very often do it on our own and in isolation.
Our field is now rife with discussion about self-care (and we note, to some
degree, unfortunately, that our blog on self-care was among the most read and
shared blogs of 2019). An aspect of our work that we only rarely discuss is
hope and how we keep hope alive.

In 1999, the late Rick Snyder produced
an excellent chapter on hope in which he broke it down into two components. The
first, “agency thinking” refers to the awareness that a goal is possible. The
second is “pathways thinking”, which involves an awareness of how to achieve a
goal. It can be enormously helpful to break hope down into these components to
see where we, as individuals, may best become more helpful to our clients,
colleagues, and selves. In our field, there has been only one article and a
book chapter, both well over ten years old, published on the topic of hope in
treatment. Nothing has been written on how professionals can remain hopeful
about their work.

The case example discussed in part 1
calls to mind that hope at the individual level may not be enough. Even if we
practice excellent self-care and keep hope alive for ourselves, how do we best
work together as teams to remain engaged in improving the systems that often
seem to do their best to spread fear, anxiety, and moral injuries?

Another recent article may begin to
yield clues about possible ways forward. Della Mosley and her colleagues recently
published on the topic of “radical hope”. Mosley er al's specific
focus is in the direction of community-based hope for marginalized groups, but
may yield insights into how professionals in our field might also become more
effective (as well as more culturally safe, humble, and competent). Mosley and
her colleagues introduce radical hope as:

“A
culturally relevant psychological framework of radical hope, which includes the
components of collective memory as well as faith and agency. Both components
require an orientation to one of four directions including individual
orientation, collective orientation, past orientation, and future orientation.”

The authors go on to describe how their
framework also “consists of pathways individuals can follow to experience
radical hope including (a) understanding the history of oppression along with
the actions of resistance taken to transform these conditions, (b) embracing
ancestral pride, (c) envisioning equitable possibilities, and (d) creating
meaning and purpose in life by adopting an orientation to social justice.”
These pathways can inform how professionals think about the hope within the work of
treating sexual aggression.

We acknowledge that the focus of Mosley’s
article isdirected toward marginalized
people (in this case, people of color) and not simply those who often work with
them. We further acknowledge being the beneficiaries of some forms of
privilege, even as our lives have not been without their own significant challenges.
Nonetheless, the idea of radical hope provides an approach that may be helpful
to us. As a start to how we might consider moving from individual self-care and
hope, professionals in our field might wish to ask:

·How can we build mechanisms of best
practice that encourages the service-user voice while recognizing the gap
between client success and key performance indicators?

·How well do we understand the systems
that so often create barriers to helping people build healthier, risk-reduced
lives for themselves?

· How well do we understand the history
of thinking that resulted in these systems functioning as they do?

·How might we better celebrate the work
that we do? After all, working with clients who have abused provides an important function in keeping our communities safe. The work we do matters, and
as recent meta-analyses have shown, the work we do can be effective, even as we
acknowledge that no efforts in any human endeavor are effective all the time.

·How can we best argue on behalf of
equitable outcomes for all of the people who come to our attention? All too
often, it seems that there are internecine rivalries between professionals of
various beliefs, including those who believe that being empathic with those who
have caused harm is somehow disrespectful of those who have been harmed (and
despite research showing that those who harm have very often been harmed
themselves).

·How can we best remind the world at
large that this work matters and is in the public interest? The simple fact is
that this work has great meaning and an important purpose.

· And finally, in terms of moral injury,
how do we remind others of the need to practice both autonomously and as
members of teams? Getting this balance right can be a true challenge. Nobody
ever said collaboration was easy.

Kieran McCartan, PhD

Chief Blogger

David Prescott, LICSW

Associate blogger

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The Association for the Treatment of Sexual Abusers (http://atsa.com/) is an international, multi-disciplinary organization dedicated to preventing sexual abuse. Through research, education, and shared learning ATSA promotes evidence based practice, public policy and community strategies that lead to the effective assessment, treatment and management of individuals who have sexually abused or are risk to abuse.

The views expressed on this blog are of the bloggers and are not necessarily those of the Association for the Treatment of Sexual Abusers, Sexual Abuse: A Journal of Research & Treatment, or Sage Journals.

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